Complexity and Fragmentation in Health Information Systems
Looking at the history of HIS in LMICs, increasing fragmentation, lack of shared standards, and poor coordination have been seen as the major challenges. In particular, since the advent of the large HIV/AIDS programmes around 2000, the tendency has been that more and more NGOs, donors, and projects have established their own parallel reporting structures greatly magnifying fragmentation. A focus on HIV/AIDS patients and expensive antiretroviral drugs made the ability to track patients and manage clinical pathways increasingly important, which again led to a proliferation of patient record systems alongside an increasing number of typically overlapping aggregate data reporting systems at the facility level. To be able to manage these big programmes’ effective integration with the general health services will require quality data, both from population and clinical care contexts.
A key challenge in this landscape of fragmented systems is the quest for integration, not only of the health service and population-based ‘HMIS’ and ‘M&E’-like systems, but also of patient-based and population-based health data and systems. Population and patient-based systems have historically evolved independently of each other, are based on different logics, and are being developed and promoted by different communities with different cultures of action. In order to be able to provide integrated information support to health systems across multiple levels of management and governance, these systems and communities need to interoperate within themselves, as also with other systems and communities, such as those for human resources, drugs and logistics, transport, insurance, finance, and many others.
Integration of HIS has been on the global agenda for a long time, but during the last few years, the situation has started to change. Led by WHO, big donor organizations are now increasingly demanding the integration of data and systems. These changes in attitudes are welcome and are being expressed at a time when the rapid spread of the internet has in fact made it easier than before. We can say we are moving from the challenge of handling fragmentation to that of handling the complexity of systems.